Mike, I really enjoyed this article and learnt and lot from it. Keep up the good work. I am strong supporter of higher clinical standards and clinical excellence in general practice and this sort of leadership helps towards innovation, especially in the context of the disturbing number of deaths from asthma.
How good is this? Very useful Thank you for this selection
There is a useful shared decision making aid on this PSA testing
Retired GP, I could not agree more, ie. to treat the causes. thank you. Your list is very helpful and I will use it, if I may. clear that multifaceted strategy and interventions needed all of which take time, but really urgent situation now as we hemorrhage GPs especially the 'last 5'
This is a really important issue.my thoughts today are with the thousands of practices up and down the country (I am on call today as well!) who are working very hard in difficult circumstances with an under-resourced general practice and fragmented rest of NHS (whilst the promising transformation/ integration initiatives take time to embed).
There has to be a better way forward. I really care about this issue. Burnout prevention is really important and a key skill that should be taught from medical schools onwards. I know some GPs and practices have found really good ways of managing these issues. Please send me any examples and or submit to bright ideas at RCGP.
In the mean time these resources are very helpful.There are other similar resources.
An important contribution, thank you
look forward to collaborating working with you
at some stage
GPs contact me regarding the need for much more support from mental health services. Specialized services tend to have narrow referral criteria for acceptance and often are not integrated within themselves e.g. addiction services/IAPT/Mental health/CRT team/ transitions with patients falling between gaps and increasing pressure on overstretched GPs services
how about 'CPN' type role based in primary care localities - generalist role
I agree taking care of yourself is really important
'HALT' is useful
Patient safety incidents more likely if you are
Angry (often resentment)
Be aware of how you are feeling, if HALT stop and take a break
avoid over-investigation for 'reassurance'- does not work
use time and watchful waiting
continue to develop/ have a confident approach to problem solving e.g. diagnosis and decision making e.g. most likely, less likely, rule out
ensure knowledge of local referral pathways usually
problems sometimes arise because doctors are uncertain of their role-helpful framework
e.g. three part role contact me for more information
Agree with GoneDoc. This is to be welcomed and is good preventative medicine with use of Statins in high risk patients. Clinician get nervous deviating from guidelines but in my experience GPs are good at selecting patients and using guidelines judiciously and they appreciate that guidelines are just that and not 'tramlines' by shared decision making
terrific article, this has helped me Fiona thank you as I have several cases in our practice. The psychological and social impact is huge. It is good to know that there is much more that can be done and careful treatment planning and liaison with specialists is key. One patient is being consider for biologic treatment.
Hello DT (| GP Partner/Principal01 Jun 2017 11:21am)
I am sorry you feel that the RCGP is not relevant to you. I would like to try and change your mind! The College is open to feedback and criticism. I do appreciate that like any large membership organisation, we have not got everything right and there will be members who will not be happy
I can give examples of achievements that can be traced back to the Royal College of General Practitioners e.g. 10.7% of NHS budget funding for general practice, the clinical pharmacy scheme, a world class specialist training scheme, invention and roll out of significant event auditing (Prof Mike Pringle)- the latter you will be using regularly in your practice and will be used daily somewhere in the UK.
Is this enough? No not by any means. There is much more to do. So that you know, I stood for election as a working GP so do understand the reality of general practice.
Let me know if you would like discuss more as I for one would hope that you will support us. Direct message me or you can also contact your local representative. Please keep an open mind It is your college! Seek change if you are unhappy -this is what the national elections are for!
Kind Regards, Mayur Lakhani
Thank you to Pulse for featuring this. I would like to take this opportunity to thank Members of the RCGP throughout the UK and in the International Faculty for electing me to be their next President. This is a responsibility that I will take very seriously. I would like to thank all the other candidates who also stood in the election and from whose perspectives I have learnt a lot. Now the hard work begins! It will be a privilege to be a national leader whilst continuing my work as a local GP and clinical lead in ongoing efforts to transform health and care. I look forward to working with the Chair of the RCGP and its other Officers, Members and Faculties to move general practice forwards.
I will do my very best to represent GPs’ interests – the President is the only officer directly elected by Members. Like any large membership organisation, I appreciate that there are GPs who do not always agree with the RCGP. I want to reassure colleagues that the College is open to feedback. And I know there is so much more to do to sustain general practice. At this critical time for general practice, we need to come together as GPs. Unity will help us tackle our challenges as there is a greater need than ever for strong professional leadership.
If you have an idea you would like me to consider than please do not hesitate to contact me
I agree that there is now with over-medicalisation of adjustment disorders. As a practising GP, it is hard to access timely high quality CBT. Des's columns are provocative and they make important points about the direction of modern medicine and public health. There is big need for CBT access.
However I cannot agree that antidepressants should not be prescribed in primary care. If used judiciously for selected patients, they can be transformative. Shabi Nabi's point about (core symptom) anhedonia is key. Risk assessment for suicide is also necessary. Let us not throw the 'baby out with the bathwater'.Where evidence may be conflicted, I would would urge GPs to be safe and consider using guidance in BNF or at CKS/NICE
What do others think?
This is very concerning speaking as someone who has experienced one episode of physical abuse and several examples of verbal abuse as a practising GP. There is very little support and you have 'get on with it'. As a GP appraiser I have met some doctors who are so abused and feel attacked by patients that they want to know if they can complain about a patient sometimes due to racist language. This combined with the spectre of complaints (with multiple jeopardy) that results in the 'second victim' syndrome, no wonder that morale and well being is at an all time low as GPs do not feel supported and the scales are balanced against them. There is evidence that GMC investigation of complaints leads doctors to practice defensively, hedging decisions, avoiding complex work with in the majority of cases, exoneration.
Having said all that the context of this must be understood. In my view despite my bruising experiences, most patients are reasonable and understand very much the pressures we work under and support GPs if they are in the know. It is not their fault if their reasonable demands and expectations of modern medicine cannot be matched by the struggling services.
It is a perfect storm for frustrations to be expressed whose first victim is loss of empathy all round. The current system does not serve patients, GPs or consultants well.
We must find a way forwards. I think we can do this. First step is even stronger leadership from doctors and professional organisations and partnerships with patients to pursue a progressive agenda
Could we for example develop measures by which general practice can sensible control/limit its workload
with an overflow to hubs
These are in many ways manifestations of burnout due to excessive workload, complexity, multimorbidity, constantly 'giving' and lack of support services compounded by fear of complaints and defensive practice
Given all this, we should be very proud of how much we are achieving and delivering
But Somehow we must find a way forward
as this is not sustainable
How can we 'keep general practice brilliant'*
I was very impressed with the RCP project on *keeping medicine brilliant'
Here an evidence base was defined was action including Eight ‘domains’ of a doctor’s working life
Physical environment needed for work
Interpersonal relations in the workplace
Hospital administration and policies (read practice)
Career, education and training
There is no magic bullet but I believe there are opportunities so we can use our initiative to improve morale and wellbeing in a holistic way
stronger national and local strategies and actions are needed
I appreciate and understand the concerns here but is this an issue that we should go to battle over?
I wonder if there is a different way of looking at this specific issue. In years of evaluating and managing ED in general practice, it is very unusual to come across a game changing diagnosis or reversible factors although of course these do occur. Many patients with the condition will be well known to their practices through long term conditions management.
Treatment is generally safe in carefully selected patients and I feel current arrangements are a barrier to getting treatment for what is for many a distressing and stigmatising condition.
Why not remove barriers and allow a highly skilled pharmacists to assess and supply treatment. This would be in keeping with enabling self care and self management and more patient responsibility. Apart from anything else, the current workload pressures mean prioritisation and we should be looking for areas where pharmacist can help us out
What do others think?
this website contains resources for GPs to support discussions about death, dying and bereavement including triggers for initiating discussion
I strong support the RCGP stance. Current mental health services are not well integrated with general practice whilst practice workload particularly in supporting patients with mental health problems and dual diagnosis is rising inexorably. Restrictive criteria and 'turf' wars between different services abound.
The practice as a hub of integration is a key principle which we must adhere to
excellent debate, I am more persuaded by Dom